“微观辨证”的产生及其发展
【关键词】微观辨证
［摘要］“微观辨证”概念的提出是中医临床诊治、循证医学发展和中医
证候学发展的需要。“微观辨证”产生的可能性是由于西医结合中西医结合和现
代科学技术的发展。“微观辨证”有其优越性和局限性，“微观辨证”的发展尚存
在一些问题，诸如：中医证候尚未规范化、微观指标单一性与整体性的矛盾、微观
指标与证候对应的非特异性、疾病对“微观辨证”产生的影响、“证”本质研究与
临床治疗脱节等。并提出“证”是疾病发生发展过程中某一阶段的病理过程，由若
干相关的主、客观指标组成，这些客观指标应包括宏观与微观、整体与局部等多个
方面的内容。
［关键词］微观辨证;证候;四诊;中西医结合
Originanddevelopmentofmicrocosmicsyndromedifferentiation
ABSTRACTThesuggestionofmicrocosmicsyndromedifferentiation
istomeettheneedsofclinicaldiagnosisandtreatmentoftraditional
Chinesemedicine(TCM)，theneedsofevidencebasedmedicineandthe
needsofthedevelopmentofsyndromedifferentiationinTCM.The
possibilityofmicrocosmicsyndromedifferentiationmightbethe
developmentofintegrationoftraditionalChineseandWesternmedicine
aswellasmodernscienceandtechnology.Microcosmicsyndrome
differentiationhasitssuperiorityandlimitation.Therearesome
problemsindevelopingmicrocosmicsyndromedifferentiation，suchas
lackofstandardforsyndromedifferentiation，contradictionbetween
singlemicrocosmicindexandtheentirety，nonspecificityofthe
relationshipbetweenmicrocosmicindexesandsyndromes，andthe
influenceofdiseaseonmicrocosmicsyndromedifferentiation，
discrepancybetweentheessencestudyofTCMsyndromesandtheclinical
practice.ItissuggestedthattheconceptofTCMsyndromeisacertain
pathologicalprocessduringtheonsetanddevelopmentofdisease，
composedofsomesubjectiveandobjectiveindexes.Theobjectiveindexes
includethemacrocosmicandthemicrocosmicindexes，theentiretyand
thepart.
KEYWORDSmicrocosmicsyndromedifferentiation;syndrome;four
diagnosticmethods;integratedtraditionalChineseandWesternmedicine
“微观辨证”的产生存在着必然性和可能性，并体现了一定的优越性、局限
性。客观地评价“微观辨证”对于中医诊断学科的发展具有促进作用。
1“微观辨证”概念的提出
1986年，沈自尹［1］首次明确提出“微观辨证”的概念，并定义：微观
辨证在临床收集辨证素材过程中，引进现代科学，